Provider Demographics
NPI:1720507742
Name:RELIANCE WALK IN MEDICAL, LLC
Entity Type:Organization
Organization Name:RELIANCE WALK IN MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:QAYYUM
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:667-215-0159
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-0188
Mailing Address - Country:US
Mailing Address - Phone:667-215-0159
Mailing Address - Fax:
Practice Address - Street 1:131 BECKS WOODS DR
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3833
Practice Address - Country:US
Practice Address - Phone:667-215-0159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care